Ultrasound imaging of the patellar tendon attachment to the tibia during puberty: a 12-month follow-up in tennis players.

This longitudinal study investigated the ultrasound appearance of the patellar tendon attachment to the tibia throughout puberty in young tennis players with and without Osgood-Schlatter disease (OSD). Twenty-eight competitive players (17 boys), aged 10.6-15.3 years, had bilateral ultrasound imaging of the patellar tendon attachment to the tibia at baseline and 1 year later. On each occasion, anthropometric measurements, pubertal status and injury history were recorded. Ultrasound appearance of the patellar tendon attachment was categorized into three stages: cartilage attachment, insertional cartilage and mature attachment. Stage 1 appearance, a large anechoic region with or without ossicles and irregularity of the apophysis that are classically associated with OSD, was found in eight players, seven of them were pain free. A majority (62%) of the patellar tendons in stage 1 at baseline progressed toward stage 2 or stage 3 1 year later. Likewise the patellar tendon attachment in most athletes with cartilage insertion showed progression to a mature enthesis over 1 year. The imaging appearance that is classically interpreted as OSD was common in asymptomatic knees. This ultrasonographic description of the patellar tendon attachment to the tibia during growth provides a reference for the assessment of bone tendon attachments in adolescents.

Prospective study of change in patellar tendon abnormality on imaging and pain over a volleyball season.

OBJECTIVE: Patellar tendon injury, defined by tendon abnormality (TA) on imaging and by pain, is common among volleyball players, but little is known about change in this injury over a volleyball season. Increased activity in the season compared with the off season may result in the development of TA and/or pain. This study investigated the behaviour of TA and pain over a competitive volleyball season. METHODS: Tendon abnormality and pain were measured in 101 volleyball players at the beginning and end of a season. Pain was measured with the single leg decline squat test, which loads the patellar tendon, and TA was detected with ultrasound imaging. Hours of weekly activity were measured and compared during the season and the off season. The proportion of tendons that underwent development and resolution in TA and/or pain over the season was investigated. RESULTS: Hours of weekly activity was greater during the season than in the off season. Most of the tendons investigated (66.3%) did not undergo a change in TA or pain over the season. Tendon abnormality and/or pain developed in 16.6% of tendons and resolved in 11.2%. CONCLUSIONS: The tendons of volleyball players respond variably to the increased load over the season. Change in TA and pain does not appear to be entirely dependent upon load.

Vascularity and pain in the patellar tendon of adult jumping athletes: a 5 month longitudinal study.

BACKGROUND: This study investigated changes in tendon vascularity in 102 (67 men and 35 women) volleyball players over a 6 month competitive season. METHODS: Athletes were examined with both grey scale ultrasound and standardised colour Doppler settings. Vessel length and pain were measured each month on five separate occasions. Vascular tendons were divided into (i) those that were vascular on all occasions (persistent vascularity) and (ii) those that were vascular on more than two but less than five occasions (intermittent vascularity). RESULTS: A total of 41 of the 133 abnormal tendons were vascular on two or more occasions. Of these, 16 had persistent vascularity and 25 had intermittent vascularity. There was no significant difference in the prevalence of vascularity between men and women. None of the tendons had a pattern of vascularity over the season that could be clearly interpreted as the onset or resolution of vascularity. Subjects with changes in both tendons were more likely to have persistent vascularity (p = 0.045). Vessels were longer in tendons with persistent vascularity (p<0.000) and pain was significantly greater (p = 0.043) than in tendons with intermittent vascularity. Tendons with intermittent vascularity had similar pain scores on all days, whether or not they had detectable blood flow. CONCLUSIONS: These data suggest that the presence of blood vessels is more likely to be the source of pain than the blood flow in them.

Ultrasound in acute and chronic knee injury.

This article presents a clinical approach to the role of ultrasound in the assessment of intra-articular and extra-articular knee pathology, including a comprehensive review of both acute and chronic conditions that may affect the tendons, ligaments, and bursae related to the knee joint. A brief review of the ultrasound findings in degenerative and inflammatory arthropathies and some of the more common tumors and masses that may be encountered around the symptomatic knee also has been included. Finally, the limited role of ultrasound in the assessment of the knee menisci and the symptomatic postarthroscopic patient is discussed.

Ultrasound changes in the wrist and hand in hemodialysis patients.

Dialysis related amyloidosis (DRA) is a common complication of chronic dialysis, but diagnosis can be difficult. Hand involvement, as carpal tunnel syndrome (CTS) or particularly amyloid hand, can affect dexterity. To investigate the prevalence and extent of hand involvement, ultrasound evaluation of the carpal tunnel and tendons of the hand was performed in 25 chronic hemodialysis patients. Clinical symptoms of CTS were present in 18/50 wrists (36%); symptomatic patients had undergone hemodialysis for a significantly longer period than those without symptoms (16 +/- 2.9 years vs 5.3 +/- 3.0 years). The ultrasound indicators suggestive of DRA in the wrist which correlated with CTS were 1) increased carpal tunnel depth (15 +/- 2.3 mm vs 11 +/- 1.5 mm), 2) increased displacement of flexor tendons from the radius (3.4 +/- 2.4 mm vs 11 +/- 0.6 mm), and 3) presence of hypoechoic masses, erosions and fluid collections (16% of wrists). There was no relationship between symptoms and either flexor retinaculum thickness or median nerve surface area index. Five patients (20%) had severe stiffness of their fingers; ultrasound revealed thickening of the tendons of the hand in all these cases. Ultrasound technology allows the non-invasive examination of the wrist and hand for DRA and may be valuable in diagnosis and planning surgery.

Interaction between playing golf and HRT on vertebral bone properties in post-menopausal women measured by QCT.

UNLABELLED: We investigated the effect of playing regular golf and HRT on lumbar and thoracic vertebral bone parameters (measured by QCT) in 72 post-menopausal women. The main finding of this study was that there was positive interaction between golf and HRT on vertebral body CSA and BMC at the thoracic 12 and lumbar 2 vertebra but not the third and seventh thoracic vertebras. INTRODUCTION: Identifying specific exercises that load the spine sufficiently to be osteogenic is an important component of primary osteoporosis prevention. The aim of this study was to determine if in postmenopausal women regular participation in golf resulted in greater paravertebral muscle mass and improved vertebral bone strength. METHODS: Forty-seven postmenopausal women who played golf regularly were compared to 25 controls. Bone parameters at the mid-vertebral body were determined by QCT at spinal levels T3, T7, T12 and L2 (cross-sectional area (CSA), total volumetric BMD (vBMD), trabecular vBMD of the central 50% of total CSA, BMC and cortical rim thickness). At T7 and L2, CSA of trunk muscles was determined. RESULTS: There was a positive interaction between golf and HRT for vertebral CSA and BMC at T12 and L2, but not at T3 or T7 (p ranging < 0.02 to 0.07). Current HRT use was associated with a 10-15% greater total and trabecular vBMD at all measured vertebral levels. Paravertebral muscle CSA did not differ between groups. Vertebral CSA was the bone parameter significantly related to muscle CSA. CONCLUSION: These findings provide preliminary evidence that playing golf may improve lower spine bone strength in postmenopausal women who are using HRT.

Abnormalities of the biceps tendon of the shoulder: sonographic findings.

The purpose of this essay is to illustrate sonographic findings for patients with abnormalities of the tendon of the long head of the biceps muscle of the arm. The tendon is vulnerable to a variety of injuries caused by abnormalities of its osseous and soft-tissue supports, including impingement of the tendon against the acromion and arthritis of the glenohumeral joint. These abnormalities include acute and chronic tenosynovitis, rupture, subluxation, and dislocation.

Massive upper gastrointestinal haemorrhage in a young man: a case of Dieulafoy's syndrome.

A 23-year-old man was admitted following a massive haematemesis. Dieulafoy's syndrome was diagnosed and the treatment was a partial proximal gastrectomy and pyloroplasty. The diagnosis and approach to surgical management of Dieulafoy's syndrome are discussed.

The value of sonography in the diagnosis of traumatic rupture of the anterior cruciate ligament of the knee.

OBJECTIVE: The purpose of this study was to test the efficacy of sonography in the diagnosis of rupture of the anterior cruciate ligament in the setting of a recent traumatic hemarthrosis. SUBJECTS AND METHODS: Sonography was prospectively performed in 37 patients with a recent traumatic hemarthrosis of the knee, no bone abnormality seen on plain radiographs, and no history of a previous knee injury. The presence of a hypoechoic collection along the lateral wall of the femoral intercondylar notch was interpreted as a hematoma at the femoral attachment of the anterior cruciate ligament. Arthroscopy was subsequently performed in 30 patients. The findings of three diagnostic techniques (sonography, MR imaging, and arthroscopy) were compared. RESULTS: The sonographic findings were confirmed by MR imaging and arthroscopy in 34 of the 37 patients. For the three false-negative results, sonographic findings were abnormal but equivocal in two cases and were reported as negative. The technique was therefore 91% sensitive and 100% specific. The positive predictive value was 100%. The negative predictive value was 63%. CONCLUSION: Sonography is a useful and inexpensive method of detecting the presence of rupture of the anterior cruciate ligament in the clinical setting of a traumatic hemarthrosis.